Migration of Filshie Clips - Effects on Sterilisation Failure?

Chai Eng Tan, Lecturer

University Kebangsaan Malaysia Medical Centre

Dear Dr Wong,

I read with interest your case report regarding migration of Filshie
clips. I have come across a migrated Filshie clip as well while reviewing
a lumbosacral radiograph done for a patient with prolapsed intervertebral
disc. She had been asymptomatic and had not conceived since the
sterilisation procedure. There have been quite a few case reports of such
incidences in PubMed (eg Connolly D et all, 2005; Verma A, 2007; Kalu E,
2006; to name a few). I just wonder how many of these cases go
undetected, in view that we do not routinely follow up these cases.

The effect of Filshie clip migration on sterilisation failure is not
known and to the best of my knowledge, has never been reported yet. What,
then, are the implications of this phenomenon? Would we need to do
periodic abdominal radiographs of women who were sterilised using Filshie
clips? Would we need to ask women incidentally diagnosed with migration
of Filshie clips to practice extra protection?

In view of the rarity of this phenomenon as well as the lack of data
on sterilisation failure, it would not be practical to do periodic
screening nor offer additional contraception to these women. However,
doctors need to be aware of these phenomenon and counsel patients on the
risks, albeit small, when offering tubal ligation with Filshie clips to
their patients.